Neurosurgery: 11/06, 7:30AM 11:00 AM

In the past two times Ive observed surgeries, theyve been wildly different experiences.
The first was cold and detached, a very mechanical process that I immediately disillusioned me
from the surgical path. The second was quiet and intimate, a process that was still surgery but
softened around the edges. Given such bipolar experiences, I wasnt quite sure what to expect
from this surgery. However, since it was Seattle Childrens, I was fairly certain that the
experience would fall closer towards the latter category just because of the optimism and
atmosphere of hope that the institution fosters.
But even that didnt quite prepare me for the dulcet tones of Tupac that greeted me as I
walked into the OR. Throwback 90s rap and hip hop accompanied the entirety of the surgery,
bringing a sense of levity to the operating room even though the gravity of the situation wasnt
undermined. I also loved that the room was lit with natural light, diminishing the sense of
sterility that often shrouds these rooms. The staff was also comprised of vibrant individuals. I
liked the personality each of them brought to their outfits (this one woman had a beautiful black
chefs hat that was patterned with peppers). Everyone in the room was also fairly young which
might have contributed to the chill if not energetic vibe of the room. It definitely wasnt an
unprofessional environment, everyone was on the top of their game, but it was pleasant to be in a
room of warm individuals. If I were to be a surgeon, I would definitely want to work in such a
relaxed room. It was so relaxed in fact that people just kind of floated in and out of the room. I
noticed that there didnt seem to be one surgeon in particular working on any case, but it was a
team effort. A couple of surgeons might take care of one part of the case, and others on the last
parts. The assisting staff also floated in between rooms. It was nice because again, it didnt seem
so claustrophobic of an environment and it just felt great to be there.
Now, as for the cases themselves. The first case I saw was a VP Shunt. Basically, the
arachnoids in the brain were not drawing off CSF correctly, so a huge cyst had formed in the
brain which would have severe neurological implications for the child. What the surgeons did
then was to insert a tube subcutaneously at the stomach and run it all the up to the head. Then,
they made a hole to the inside of the cyst, and ran the tube from the stomach into the brain. This
way, the CSF would be drawn off slowly and just drain out in a stomach collection bag. Given
the nature of the procedure, the surgeons only removed a little skin so its not like I saw the
entire brain open. Also, when they were puncturing the tunnel to the cyst, it was surprising to see
them use what looked like a thick metal nail. One surgeon punctured a tunnel while the other
held a cauterizer to it and basically tunneled the hole using pressure and heat. I was pretty
surprised that they didnt have to use a drill, it just kind of pushed in like butter. Since it wasnt
an open brain surgery, all the visualization was done using real time MRI imaging. They had
already determined how deep the shunt would be, so the surgeon had several angles on the brain
that helped guide him to the spot. Its funny, the first couple of times he wasnt able to follow the
path properly, and one of the other surgeons said If this was a video game, youd be dead
already. It must be difficult looking one way but what youre doing being in a different
direction, but thats just the way surgery is going to be nowadays because of how much
laparoscopy is being utilized. I guess the most surprising thing about this procedure was how
purely mechanical and simple it was: there was too much fluid, so they ran a pipe up to it and
that was that. I guess I expected neurosurgery to be more dramatic, but it wasnt like that at all.
Perhaps its just because of the nature of the case.
The second case was a little more involved. The patient had stenosis in their sutures. Id
never heard of stenosis in anything other than vessels, but basically the cranial sutures were stiff

when they should be flexible as they fuse in the first two years of life. Because of the stenosis,
the cranium would not fuse properly. For this one, the surgeons made a long zigzag incision
across the scalp and then peeled back all the skin. For some reason, seeing that made me kind of
squeamish. I think it was just because I could see the patients ears right next to this flappy skin
that had been pulled back and then seeing the cranium in all its bloody glory. The next thing they
did was draw a latticed pattern on the cranium with the cauterizer, and then drilled small holes at
each vertices. Then they slipped a bone saw into the hole and cut across the lattice lines. The
bone saws design was nifty: it has a flat tip upon which the saw sits, so that way the brain is
protected. When it was all finished, the way they opened up the cranium looked like how my
mom cuts open pomelos. After opening everything up, they cleaned up some of the rough edges
of the sutures and where the stenosis was, then drilled little holes into each flap and sutured them
together. And that was that.
Surgery is engaging and exciting, thats for certain. But I dont know that I would find it
fulfilling in the same way as being a primary care professional or some other physician who does
consultations. I know now that surgery isnt the sterile or inhuman environment that I thought it
was before because there is a very nice communal vibe among the staff, but the patient
interaction is just weird for me. The fulfilment that Im seeking is making a difference in a
patients life, and that surgery accomplishes that theres no doubt, but its a different sort of
accomplishment when youre speaking with the patient and engaging with them when theyre
conscious and taking steps to make a difference in their entire life. So I could do surgery, but I
know that I wouldnt love it.